CPT code 93970 illustrates the duplex scan of extremity veins, including responses to compression and other manoeuvres, complete bilateral study.
The CPT code 93970, as preserved and described by American Medical Association (AMA), is a medical diagnostic, procedural code for non-invasive extremity venous studies.
Duplex scanning to evaluate blood flow is a non-invasive diagnostic technique.
First, a medic can get illustrations of peripheral vessels.
Then, the provider may determine the patterns of blood flow in peripheral vessels with the help of ultrasound imaging and pulsed Doppler mechanism in real-time.
This process can also diagnose the presence of stenosis, occlusion, and identification of incompetent veins.
CPT Code 93970 Description
Doppler ultrasound is a unique technique that evaluates the movement of materials in the body.
For example, it permits the provider to perceive and assess blood flow through arteries and veins in the body.
Doppler Ultrasound imaging (CPT code 93970) is a non-invasive diagnostic radiological procedure that helps providers diagnose and treats medical disorders.
It is a safe and painless procedure. Duplex scanning uses high-frequency ultrasound waves to analyze arteries and veins’ blood flow pattern and direction.
Venous duplex (CPT code 93970) provides live images of the veins responsible for blood circulation in the upper or lower extremities.
Doppler ultrasound is a unique ultrasound technique that evaluates blood movements.
So, the provider can access and diagnose venous disorders.
The skilled worker executes the procedure with the help of an infinite instrument called a transducer.
A particular gel type is applied directly to the target area’s skin. The technician uses a small amount of gel on the skin for investigation and places the transducer there.
The waves (sound) of high-frequency travel from the probe through the gel into the target area.
The search collects the sounds waves that bounce back.
A computer uses those ultrasonic waves and produces an image because ultrasound captures images in real-time.
It can show the structure and blood perfusion in its internal organs.
Duplex scanning of extremity veins (CPT code 93970) includes the peripheral venous system of unique arms.
A special ultrasound technique measures the direction and speed of blood cells as they move through blood vessels.
The upper extremity vein order is a cephalic vein, median cubital vein, and basilica vein.
In the legs, the venous system includes the internal and external iliac veins, femoral veins, saphenous veins, popliteal vein, tibia vein, and arch of the foot.
Duplex scanning is a less expensive, reliable, and most common diagnostic imaging method.
Duplex scanning is very safe and does not involve any hazardous radiation.
The ultrasound scanning usage permits the illustration of soft tissues that do not show up clearly on other basic radiology techniques, e.g., X-ray, fluoroscopy, etc.
Venous ultrasound helps detect blood color extremities’ deep veins, which is a severe condition.
Moreover, it may be fatal if not detected and treated timely.
A Venous Duplex Scan (CPT 93970) provides complete images of these blood vessels that help the provider determine the degree and cause of limited blood flow and identify venous disease.
Common Billable Diagnosis For Duplex Scanning
Duplex scanning of extremity veins (CPT 93970) offers to evaluate symptoms including leg pain or swelling, leg heaviness, excessive varicose veins, change in leg color, shortness of breath, or suspected blood clots in your legs and lungs.
One of the fatal co-morbidity disorders is a pulmonary embolism, the sudden blockage of the pulsing vein usually by a blood clot that may have traveled from the legs to the lungs.
Deep vein thrombosis can be a severe medical condition when a blood clot forms in a deep vein.
And it could cause co-morbidity or any other chronic circulation system disorder.
These clots usually develop in the lower extremities, i.e., thigh.
Still, they can also occur in arms, more common in bedridden patients.
Because of advanced ultrasonic or other imaging techniques, DVT is preventable and treatable if discovered early.
Duplex ultrasound is a non-invasive determination of blood flow in the arteries and veins that comprises time images.
And it integrates B-mode, two-dimensional vascular structure, Doppler spectral analysis, and color flow Doppler imaging.
Doppler ultrasound (CPT 93970) helps the doctor detect and evaluate the blockages in blood flow (such as clots).
The tumors, blood vessels narrowing, and congenital vascular malformations reduced or absent blood flow to various organs, such as the testes or ovary.
Increased blood flow in vessels may be a sign of infection.
While coding for duplex scans, the coder must have appropriate medical terminology knowledge and skill to read the radiological notes.
Appropriate CPT code and application of specific modifiers depend on skill and experience.
93970 CPT code includes both literalities in its definition in words as it is a complete bilateral study.
Another CPT with the same category is 93971, used when performed on a unilateral site such as the left or right side of the lower extremity.
CPT Code 93970 Billing Guidelines
When reporting 93970 CPT code, the duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study, and the following must be available in documentation: superficial femoral vein, common femoral vein, more significant saphenous, popliteal veins, and proximal deep femoral vein.
The provider may also evaluate the calf veins.
To allocate CPT 93970 for an upper extremity study, the subclavian, jugular, axillary, bra, chill, cephalic veins must be considered.
Evaluation of veins in the forearm represents the studies performed on the upper extremities.
Suppose one or more segments are missing in the documentation.
In that case, report CPT 93971; narrates as the duplex scan of veins (extremity) with the inclusion of specific reactions to compaction and many other maneuvers.
American Medical Association (AMA) requires spectral and color Doppler imaging to bill the CPT 93970.
Therefore, documentation of all duplex scan studies should reflect the assessment of flow with color and recording a spectral waveform.
Additional documentation requirements to bill CPT 93970 is as, if the flow is not available for visualization, the documentation should reflect that the spectral Doppler evaluation revealed no flow.
In addition, documentation should reflect a typical waveform as it is necessary to describe the whole procedure in detail.
The provider can use this information to select related MIPS reporting measures appropriately.
The coder or biller can bill CPT 93970 twice if the health professional accomplishes venous duplex scans of the upper and lower extremities on the same DOS (date of service).
To differentiate the area of executed services, one must use modifiers 59 or X (EPSU).
When needed, the service can be billed more than once in a single claim as per the CMS – MUE adjudication indicator regulations.
In the above scenario, appropriate selection of ICD 10 CM is the key, as improper diagnosis code selection affects the claim’s first pass ratio.
Also, it is the provider’s responsibility to ensure that the radiology report has the final diagnosis code at the highest level of specificity.
The coder should avoid using unspecified diagnosis codes while coding for the radiology segment.
However, suppose the necessary information is missing in a report. In that case, the coder should send the medical notes back to the provider so they can add appropriate data accordingly.
Most insurances provide a maximum of 60 days’ time window for the corrections or any additions in a medical record as an addendum duly signed by the provider.
The coder should submit the primary code in a claim per States local coverage determination policy.
Different insurances also have a list of approved diagnosis codes to fulfill the medical necessity.
For this reason, prior authorization is the key to minimizing the practice revenue losses.
CPT Code 93970 Reimbursement
The national physician fee schedule (PFS) in a facility for the duplex scan is $195.87, and in non-facility, PFS is $195.87.
For CPT 93971 national physician fee schedule (PFS) in a facility for the duplex scan is $124.24.
In a non-facility, PFS is $124.24.
Incorrect selection of CPT directly affects the revenue of the practice.
While performing the duplex scan, the highest skilled technologist is the primary requirement because the duplex scan is a complex procedure.
Because of the complexity of the technique, the technician gets increased reimbursement compared to the physician.
The payments under technician NPI are higher at $189.60, and the cost under physician NPI is $36.17.
This service is billed twice in two different claims with modifier 26 and TC separately to split their payments because they provide services individually.
CPT Code 93970 Modifiers
Modifiers are used with duplex scan CPT code 93970 to present certain circumstances to quay for payments.
Each modifier carries its definition and application circumstances. The coder can use several modifiers with duplex scan CPT 93970 described as below:
Modifier TC (Technical Component) usage shows that duplex scan 93970 is billable under technician NPI.
Simultaneously, Modifier 26 (professional Component) with CPT 93970 is required to bill under physician NPI.
The description of modifier 59 represents the different procedural services.
This modifier is used with CPT 93970 when billed more than once on a single service date for the same patient.
For example, when upper and lower extremities bilaterally are evaluated, it is compulsory to add modifier 59 or X (EPSU).
It represents that procedure performed on different anatomical sites; otherwise, the covering companies may deny the claim.
There is a massive difference in the two adjacent CPTs (93970 and 93971).
The main difference is CPT 93970 is a bilateral complete duplex study, while CPT 93971 defines as unilateral.
Suppose the health professional scans the exact location (upper extremities or lower extremities) more than once on the same DOS (date of service) by the same provider.
In that case, one may use modifier 76 (repeat procedure by the same physician) to make a claim eligible for payment by insurance.
In some cases, a health professional executes the duplex scan (CPT 93970) for either upper or lower extremities at the exact service date, but the provider is different.
In such cases, modifier 77 (repeat procedure by another physician) is applied in the second claim and billed with appropriate medical necessity.
The health professional may order to repeat scans on the same DOS for several reasons.
The most common example is to evaluate the effects of post pharmacological intervention in the case of deep vein stenosis.
One must not use laterality modifiers: such as modifier 50, modifier LT, and modifier RT with CPT 93970.
Because, as per the description of the duplex scan procedure, it inherently includes bilateral extremities.
The modifier represents services performed under the ABN contract, in such cases, are likely to be non-covered.
For example, it is because of medical necessity or the payers’ coverage criteria.
The GA modifier shows that physicians need to represent what they anticipated that Medicare might deny a standard service as not reasonable and necessary.
They have an ABN duly signed by the patient on file.
The GZ modifier usage shows that providers want to indicate that they believe that Medicare may deny the same service as not reasonable and necessary.
They do not have an ABN duly signed by the patient.
Getting prior authorization from individual insurance is always a better option so that the practice can avoid the burden of denials caused by coverage or medical necessity issues.
A male, age 52 – years old, came to the Provo office having a symptom of bilateral leg swelling, skin discoloration, and severe pain.
After the physical examination, the provider decided to go for a complete duplex scanning of the lower extremities because these symptoms were closely related to deep vein thrombosis.
The imaging result shows that patient is suffering from bilateral deep vein thrombosis.
For the above case, the procedure represents CPT 93970, and the diagnosis to fulfill the medical necessity is i82.403.
The coder or biller should bill the CPT without any technical or professional component modifier to ensure that the provider is getting complete reimbursements for the service.